Arizona State Board of Funeral Directors and Embalmers

A REPORT TO THE ARIZONA LEGISLATURE Performance Audit Division Performance Audit and Sunset Review Arizona State Board of Funeral Directors and Embalmers September 2013 REPORT NO. 13-11 Debra K. Davenport Auditor General

The Auditor General is appointed by the Joint Legislative Audit Committee, a bipartisan committee composed of five senators and five representatives. Her mission is to provide independent and impartial information and specific recommendations to improve the operations of state and local government entities. To this end, she provides financial audits and accounting services to the State and political subdivisions, investigates possible misuse of public monies, and conducts performance audits of school districts, state agencies, and the programs they administer. The Joint Legislative Audit Committee Senator Chester Crandell, Chair Senator Judy Burges Senator Steve Gallardo Senator Katie Hobbs Senator Andy Biggs (ex officio) Representative John Allen, Vice Chair Representative Paul Boyer Representative Andrea Dalessandro Representative Martin Quezada Representative Kelly Townsend Representative Andy Tobin (ex officio) Audit Staff Dale Chapman, Director Jeremy Weber, Manager and Contact Person Brian Miele, Team Leader Laura Long Genny Wilson Copies of the Auditor General s reports are free. You may request them by contacting us at: Office of the Auditor General 2910 N. 44th Street, Suite 410 Phoenix, AZ 85018 (602) 553-0333 Additionally, many of our reports can be found in electronic format at: www.azauditor.gov

DEBRA K. DAVENPORT, CPA AUDITOR GENERAL STATE OF ARIZONA OFFICE OF THE AUDITOR GENERAL MELANIE M. CHESNEY DEPUTY AUDITOR GENERAL September 23, 2013 Members of the Arizona Legislature The Honorable Janice K. Brewer, Governor Mr. John Munden, President Arizona State Board of Funeral Directors and Embalmers Mr. Rodolfo Thomas, Executive Director Arizona State Board of Funeral Directors and Embalmers Transmitted herewith is a report of the Auditor General, A Performance Audit and Sunset Review of the Arizona State Board of Funeral Directors and Embalmers. This report is in response to an October 26, 2010, resolution of the Joint Legislative Audit Committee. The performance audit was conducted as part of the sunset review process prescribed in Arizona Revised Statutes 41-2951 et seq. I am also transmitting within this report a copy of the Report Highlights for this audit to provide a quick summary for your convenience. As outlined in its response, the Arizona State Board of Funeral Directors and Embalmers agrees with all of the findings and plans to implement all of the recommendations. My staff and I will be pleased to discuss or clarify items in the report. Sincerely, Debbie Davenport Auditor General Attachment cc: Arizona State Board of Funeral Directors and Embalmers Members 2910 NORTH 44 th STREET SUITE 410 PHOENIX, ARIZONA 85018 (602) 553-0333 FAX (602) 553-0051

Arizona State Board of Funeral Directors and Embalmers REPORT HIGHLIGHTS PERFORMANCE AUDIT Our Conclusion The Arizona State Board of Funeral Directors and S Embalmers (Board) regulates individuals and facilities involved in funeral directing, embalming, and cremation. The Board should strengthen its licensing process by ensuring that application forms are consistent with all of its administrative rules (rules). The Board should also apply late fees for untimely renewals, ensure that its renewal application forms are consistent with rules, and either audit continuing education or (1 require documentation of it with the renewal application. In addition, the Board needs to improve its inspection process by inspecting facilities at least once every 5 years, as required by statute, and by better a documenting inspection results and following up on deficiencies. Finally, the Board adequately investigated e and resolved complaints in a timely manner, but should implement procedures for providing accurate and complete public information about those it regulates. 2010 2013 September Report No. 13-11 Board should improve its licensing functions As of April 2013, the Board had 1,510 licensees, consisting of funeral establishments, funeral directors, embalmers, interns, crematories, and cremationists; registered 90 embalmer assistants and prearranged funeral salespersons; and endorsed 25 licensed funeral establishments to sell prearranged funerals. Board applications inconsistent with rules Although the Board ensured that applicants for licenses supplied all the information required by its license applications, application forms did not request all the information required by its rules. For example, rule requires that an applicant disclose dishonest, negligent, or criminal conduct that occurred in the past 5 years, but the application did not specifically ask about such conduct. Renewal applications were also missing several minor items required by its rules. Board inappropriately processed late renewals Licenses and registrations should be renewed by July 1 of each year. If the person renewing fails to meet the July 1 deadline but submits the renewal before August 1, the applicant must also pay a late fee along with the renewal fee. However, if the August 1 deadline is missed, the person must submit an initial application and fee. We reviewed a sample of 16 renewal applications and found that 5 renewal applications were submitted after July 1 but before August 1, and 3 of those were not charged the late fee. Another 2 renewal applications were submitted after August 1, but the Board did not require the licensees to reapply for licenses. Board should verify continuing education hours Licensees and registrants are required to complete continuing education hours before they apply for renewal. Although the application requires information about the classes and hours taken, the Board does not follow up to ensure that the training was actually completed. To help ensure that licensees/registrants complete their continuing education requirements, the Board should either follow up on a sample of renewal applications to verify the completion of continuing education or require licensees/registrants to submit proof that they completed the continuing education. Recommendations The Board should: Revise its application forms so they are consistent with all rule requirements; Ensure that it collects late fees and requires reapplication as necessary; and Follow up on a sample of renewal applications or require documentation to ensure that continuing education requirements are met. Board should improve its inspection process Board failed to inspect about half its facilities in time frame required by statute The Board is statutorily required to inspect each funeral establishment and crematory at least once every 5 years. There are about 200 such facilities that the Board regulates, but we estimated that it had inspected only 92 facilities between January 2008 and December 2012. The importance of these inspections is illustrated by an

April 2011 television station s news report that indicated that a crematory had stacked human bodies waiting for cremation in unrefrigerated vans for at least 19 hours because there were too many bodies to fit in the crematory s cooling system. Following the news report, the Board inspected the crematory for the first time in more than 4½ years and subsequently revoked its license. As a result of our audit, the Board conducted 147 inspections from January through April 2013, and indicated that it caught up on its inspections by May 2013. Board did not adequately document all inspection results Although the Board has inspection checklists, it did not consistently or completely document inspection results. We reviewed a random sample of 20 funeral facility inspection files, each containing checklists for one or more inspections conducted between calendar years 2002 and 2013, and found that for at least 12 of the inspection files, a checklist was not appropriately completed or the inspection results were unclear. For example, the Board s inspector rarely completed the entire portion of the checklist section that involved a review of customer files for appropriate documentation, such as consent to embalm or cremate, potentially indicating that the review was not done. Board neglected to appropriately conduct and document inspection followup The Board has procedures to follow up on deficiencies discovered during inspections, but did not follow these procedures. For the 20 funeral facility inspection files we reviewed, at least 16 facilities had one or more inspections with identified deficiencies, but none had corrective action plans, as required by rule. Although the inspector did some follow-up work, at least 8 of the 16 facility inspection files had insufficient information to determine whether the funeral facility had corrected deficiencies. The Board has begun to take action to address the factors that contributed to inspection shortcomings. For example, the Board has begun revising its inspections procedures, and a new inspector has been hired and will meet regularly with the Executive Director to review inspection progress and plans. Recommendations The Board should: Ensure that each facility is inspected at least once every 5 years, track inspection progress, and fully complete inspection checklists; Follow up, as required by rule, on inspections where deficiencies are identified, and obtain appropriate evidence of and document corrective action; and Have its Executive Director conduct random, supervisory reviews of inspection files. Board should improve its provision of information to public Information about licensee discipline is available on the Board s Web site. At the beginning of our audit, the Web site also had information about dismissed complaints and nondisciplinary actions, which should be publicly available but is not statutorily allowed on the Board s Web site. The Board has since fixed this issue. In two instances, some disciplinary information was not available on the Web site because it was improperly entered into the Board s data system. In addition, the Board did not always provide adequate information about licensees over the phone. Specifically, for three of four calls we placed to the Board about licensees, board staff did not provide complete information because they did not know what information they should provide to the public. Recommendations The Board should: Implement its revised policy and procedures that will help prevent staff from making inaccurate computer entries that prevent discipline records from being displayed on its Web site; and Ensure that staff follow its January 2013 procedure for providing complete information about licensees and registrants over the phone. Arizona State Board of Funeral Directors and Embalmers A copy of the full report is available at: www.azauditor.gov Contact person: Jeremy Weber (602) 553-0333 REPORT HIGHLIGHTS PERFORMANCE AUDIT September ember 2013 2010 Report No. 13-11 10-03

TABLE OF CONTENTS Introduction 1 Licensing 5 Board ensured licensure applicants submitted required documents but should strengthen its license, registration, and endorsement application forms 5 Board should collect late renewal fees and better ensure renewal requirements are met 6 Board complies with time frames for issuing licenses, registrations, and endorsements, and for renewing licenses and registrations 8 Recommendations 8 Inspections 11 Board should improve its inspection process to better protect consumers 11 Recommendations 14 Complaint resolution 15 Board adequately investigated and resolved complaints in a timely manner 15 Public Information 17 Board should improve its provision of public information 17 Recommendations 18 Sunset factor analysis 19 continued Office of the Auditor General page i

TABLE OF CONTENTS Appendix A: Methodology a-1 Agency Response Tables 1 Number of licenses, registrations, and endorsements As of April 29, 2013 1 2 Schedule of revenues, expenditures, and changes in fund balance Fiscal years 2011 through 2013 (Unaudited) 3 concluded State of Arizona page ii

Introduction Audit scope and objectives The Office of the Auditor General has conducted a performance audit and sunset review of the Arizona State Board of Funeral Directors and Embalmers (Board) pursuant to an October 26, 2010, resolution of the Joint Legislative Audit Committee. This audit was conducted as part of the sunset review process prescribed in Arizona Revised Statutes (A.R.S.) 41-2951 et seq and addresses the Board s licensing process, which includes issuing and renewing licenses, registrations, and endorsements; licensed facility inspection program; complaint resolution process; and provision of information to the public. It also includes responses to the statutory sunset factors. Mission and responsibilities The Board was established in 1945 to regulate funeral establishments and the practices of funeral directing and embalming and to protect consumers from financial harm. The Board s mission is to maintain and enforce a set of standards for those it regulates to provide protection for the health, safety, and welfare of Arizona citizens. The Board s responsibilities include: Licensing and registering professionals and licensing and endorsing facilities The Board licenses individuals and facilities (funeral establishments and crematories) involved in funeral directing, embalming, and cremation. In addition, the Board registers embalmer assistants and prearranged funeral salespersons, and endorses licensed funeral establishments to sell prearranged funeral agreements funded by a trust. As of April 2013, the Board had 1,510 licenses, 90 registrants, and 25 endorsees (see Table 1 for details). According to its database, the Board processed 165 applications for licenses, registrations, or endorsements each year, on average, between calendar years 2008 and 2012. 1 Table 1: Number of licenses, registrations, and endorsements As of April 29, 2013 Licenses Facility licenses Funeral establishment 169 Crematory 52 Total facility licenses 221 Individual licenses Funeral director 463 Funeral director at multiple establishments 22 Embalmer 500 Intern 27 Cremationist 277 Total individual licenses 1,289 Total licenses 1,510 Registrations Embalmer assistant 18 Prearranged funeral salesperson 72 Total registrations 90 Endorsements Allows a licensed facility to sell prearranged funeral agreements funded by a trust 25 Source: Auditor General staff analysis of board database downloaded on April 29, 2013. 1 The Board reported that, as of September 2013, it will begin processing applications for intern trainees (see Sunset Factor 8, page 21, for additional information). Office of the Auditor General page 1

Conducting inspections The Board is required to inspect its licensed facilities at least once every 5 years to ensure compliance with statutory and rule requirements, such as appropriately providing prices and disclosure statements to customers in funeral establishments and adequately identifying and respecting human remains in crematories. Based on an analysis of board records, auditors estimated that the Board inspected 92 facilities between January 2008 and December 2012. During the audit, according to the Board s database, the Board conducted an additional 147 inspections from January through April 2013 (see the Inspections chapter, pages 11 through 14, for additional information). Resolving complaints The Board is responsible for investigating complaints against licensed or registered individuals and licensed facilities and takes statutorily authorized nondisciplinary or disciplinary action, as needed. For calendar years 2010 through 2012, the Board opened a total of 15 complaints: 6 were dismissed, 4 resulted in nondisciplinary letters of concern, and 5 resulted in discipline. Providing information to the public The Board provides information about the individuals and facilities that it regulates, including disciplinary history, on its Web site. In addition, the Board publishes agendas and minutes of its public meetings, an annual newsletter, and a substantive policy statement on its Web site. Finally, board staff also respond to public requests for information. Organization and staffing The Board consists of seven governor-appointed members: four practicing funeral directors or embalmers and three public members, one of whom owns or manages a business unrelated to the funeral industry. The Board was authorized four full-time equivalent (FTE) staff positions for fiscal year 2013, but indicated it was funded for only the three FTE positions that it had filled as of June 2013. Budget The Board does not receive any State General Fund appropriations. Rather, its revenues consist primarily of license and registration fees. A.R.S. 32-1308 and 32-1368 require the Board to remit to the State General Fund 100 percent of all collected penalties and 10 percent of other revenues except for interest on investments and administrative fees collected to defray the cost of investigations. As shown in Table 2 (see page 3), the Board s fiscal year 2013 net revenues were approximately $311,000. Personnel costs account for the majority of the Board s expenditures, which totaled more than $327,600 in fiscal year 2013. The Board s fiscal year 2013 ending fund balance was more than $293,500. State of Arizona page 2

Table 2: Schedule of revenues, expenditures, and changes in fund balance Fiscal years 2011 through 2013 (Unaudited) 2011 2012 2013 Revenues 1 $ 355,174 $ 365,059 $ 344,637 Remittances to the State General Fund 2 (34,446) (38,352) (33,626) Net revenues 320,728 326,707 311,011 Expenditures 284,718 289,808 327,658 Transfers to the State General Fund 4 9,600 6,100 Total expenditures and transfers 294,318 295,908 327,658 Net change in fund balance 26,410 30,799 (16,647) Fund balance, beginning of year 252,971 279,381 310,180 Fund balance, end of year $ 279,381 $ 310,180 $ 293,533 3 1 Amount consists primarily of license and registration fees. 2 As required by A.R.S. 32-1308 and 32-1368, the Board remits to the State General Fund 100 percent of all collected penalties and 10 percent of other revenues except for interest on investments and administrative fees collected to defray the cost of investigations. The Board also retains 100 percent of charges for a consumer guide it sells to the public at cost. 3 Amount increased in fiscal year 2013 primarily because payroll expenditures increased. According to the Department of Administration, State Boards Office, payroll expenditures primarily increased because of a 5 percent critical retention payment to all uncovered employees as authorized by Laws 2012, Ch. 294, 133; a payout of annual leave balances when a board inspector retired; and the retired employee s position being double-filled for a short period of time while the new inspector was learning the position. 4 Amount consists of transfers to the State General Fund in accordance with Laws 2010, 7th S.S., Ch. 1, 148 and Laws 2011, Ch. 24, 108, 129, and 138, to provide support for state agencies. Source: Auditor General staff analysis of the Arizona Financial Information System (AFIS) Accounting Event Transaction File for fiscal years 2011 and 2012 and the AFIS Management Information System Status of General Ledger-Trial Balance screen for fiscal years 2011 through 2013. Office of the Auditor General page 3

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Licensing Although the Board ensured that applicants submitted required information to demonstrate qualifications for licensure, it should strengthen its license, registration, and endorsement application forms to ensure they are consistent with its rules. Additionally, the Board should collect late renewal fees and better ensure continuing education requirements are met. Finally, the Board issued initial and renewal licenses and registrations in a timely manner. Board ensured licensure applicants submitted required documents but should strengthen its license, registration, and endorsement application forms The Arizona State Board of Funeral Directors and Embalmers (Board) ensured that applicants submitted documentation that it had required of them to become licensed, but it should strengthen its licensing, registration, and endorsement processes to be consistent with board-established administrative rules. The Board issues and annually renews various licenses to individuals and facilities in the funeral industry. Board statutes, along with rules in the Arizona Administrative Code (AAC), outline specific requirements for licensure, which vary according to the seven different types of licenses the Board issues (see textbox for examples). 1 Auditors reviewed a random sample of 15 license applications that the Board approved in fiscal years 2002 through 2013 and found that the Board ensured the applicants submitted the documentation it had required prior to issuing the licenses. Specifically, board staff collected and retained required documents such as a copy of the license application, results of the criminal background check, transcripts, and exam results. Example license requirements Funeral director Must submit an application form provided by the Board; be of good moral character; have held an embalmer s license for at least one year; have assisted in arranging and directing at least 25 funerals; and pass funeral licensure and state law exams. Cremationist Must submit an application form provided by the Board; be of good moral character; and complete a crematory certification program. Funeral establishment or crematory Must submit an application form provided by the Board; be of good moral character; submit a copy of the partnership agreement, articles of incorporation, or any other organizational documents; and pass a board inspection. Source: Auditor General staff review of Arizona Revised Statutes (A.R.S.) 32-1322, 32-1323, 32-1383, 32-1394.01, 32-1395, and AAC R4-12-210. However, the Board should strengthen its licensing, registration, and endorsement processes by ensuring its application forms are consistent with its rules. For example, the Board s license application forms do not ask applicants for all the information required by its rules. Specifically, although required by rule, the Board s application forms for initial licensure do not ask applicants to disclose whether, in the past 5 years, they have committed any act involving dishonesty, fraud, misrepresentation, breach of fiduciary duty, 1 In addition to the seven licenses, the Board also issues two types of registrations and one endorsement (see the Introduction, page 1, for additional information). Office of the Auditor General page 5

gross negligence, or incompetence reasonably related to the applicant s proposed area of licensure. Board rules also require applicants for licensure to disclose whether they are currently incarcerated or on community supervision after a period of imprisonment, but the application forms likewise do not ask for this information. Further, the board application forms for licensure are inconsistent with some rule requirements. For example, board rules require applicants to provide information regarding felony and certain misdemeanor convictions within 5 years from the date of the application, such as the court of jurisdiction, the probation officer s contact information, and other applicable documents. However, the board application forms require applicants to provide this information for any felonies or misdemeanor convictions, regardless of when they occurred. In addition, applicants for a registration or endorsement must meet certain requirements that are similar to licensure applicants, but the registration and endorsement application forms have inconsistencies similar to those in the license application forms. Board staff noted that the Board had other processes in place to compensate for the omissions in its application forms, but these processes do not provide the same degree of assurance that the revised forms would provide. For example, the Board indicated that if an applicant was licensed in another state, the other state would inform the Board whether the applicant had received any disciplinary action, which would help the Board know if the applicant had been involved in dishonesty, fraud, misrepresentation, breach of fiduciary duty, gross negligence, or incompetence related to the applicant s proposed area of licensure. However, this process does not provide information to the Board for applicants who have not been licensed in another state. Because these compensating processes cannot always assure the Board that an applicant is qualified and thus places the State at greater risk for licensing unqualified applicants, the Board should ensure that its application forms are consistent with its established rules. During the audit, the Board made revisions to some of its licensing application forms to make them more consistent with some rule requirements; however, the areas mentioned previously had not been addressed. Therefore, the Board should further revise its licensing, registration, and endorsement application forms so that they are consistent with all of its rule requirements. In addition, the Board has not updated its licensing, registration, and endorsement policies and procedures since it adopted new administrative rules in 2001 that revised related requirements. When policies and procedures do not reflect current statutory and rule requirements, board staff are at risk of not complying with these requirements. Therefore, the Board should develop and implement policies and procedures to ensure that all licensure, registration, and endorsement requirements, including any future revisions to these requirements, are accurately reflected in its policies and procedures. Board should collect late renewal fees and better ensure renewal requirements are met Auditors identified several ways in which the Board s processes for renewing licenses and registrations can be improved. The Board is required to renew licenses, registrations, and endorsements each year. For example, A.R.S. 32-1331 requires licensees and registrants to submit a renewal application and fees to the Board by July 1 of each year. If the renewal application is State of Arizona page 6

submitted between July 2 and August 1, statute requires the Board to charge a late fee. If the renewal application is submitted after August 1, statute requires the applicant to reapply for licensure or apply for reinstatement of the registration. Finally, licensees and embalmer assistant registrants must submit a list of the continuing education they have completed each year, unless the Board waives the requirement for an approved reason. A review of renewal applications found several shortcomings in how the Board processed renewal applications. Auditors reviewed a random sample of 16 renewal license or registration applications submitted to the Board in calendar year 2012 and found that the licensees/registrants had returned completed renewal applications and fees. However, the Board did not always charge appropriate late fees as required by statute, its renewal application was not completely consistent with its administrative rules, and it lacked procedures some other Arizona regulatory boards use to help ensure their licensees comply with continuing education requirements. As a result, the Board should enhance its renewal process to ensure that licensees/registrants better meet all renewal requirements. Specifically: Board should collect late fees or require licensees/registrants to reapply if their renewal application forms are past due For the 16 license/registration renewal application forms reviewed, 7 were submitted late 5 between July 2 and August 1 (and therefore subject to late fees) and 2 were submitted after August 1 (and therefore subject to reapplication). Auditors found that the Board did not charge a late fee to 3 of the 5 licensees who had submitted their renewal applications and fees after July 1, but before August 1. In addition, the Board did not require the 2 licensees who submitted their renewal applications after August 1 to reapply for licensure. Instead, the Board renewed their licenses. A board official indicated that the staff member who incorrectly processed these renewal applications made careless errors and, in the future, the Board would process late renewal applications in keeping with the statutory requirements. To ensure that the Board has an appropriate process for collecting late fees and ensuring that licensees/registrants reapply as required, the Board should develop and implement policies and procedures to guide the renewal process and ensure staff receive adequate supervisory oversight. Board should ensure that its renewal application forms are consistent with rule The Board s renewal application forms have some inconsistencies with requirements in rule. For example, the license renewal application form instructs licensees to have the form postmarked by July 1, while rule requires that the form be received by July 1. The Board reported that it will revise its renewal forms accordingly. In addition, the renewal forms do not contain several other minor items required in rule, such as the licensee s social security number and phone number. Board staff said these items, while required in rule, are not necessary. In such cases, the Board should determine whether to revise its renewal application forms or revise its rules. However, unless and until it revises its rules to change the renewal requirements, the Board should ensure its renewal application forms request all information required in rule. Board should either audit continuing education or require documentation Board rules require that, prior to renewal, licensees complete 12 credit hours of continuing education, including 3 hours in mortuary sciences, 3 hours in ethics, and 6 other hours intended to enhance professional development or competence. In addition, embalmer assistant registrants must Office of the Auditor General page 7

complete 6 credit hours of continuing education prior to renewal, including 3 hours in mortuary sciences and 3 hours covering compliance with state and federal laws. Renewal application forms include space for the licensee/registrant to list the title, date, and credit hours of each continuing education course along with a signed statement that the licensee/registrant took the continuing education. However, according to board staff, they do not conduct any followup to verify that the training was actually completed. To help ensure licensees/registrants meet the continuing education requirements, the Board should follow some other Arizona state regulatory boards practices by either following up on a sample of renewal applications to verify that the licensee/registrant has completed the continuing education, or by requiring all licensees/ registrants to submit proof that they have completed the continuing education, such as a certificate of completion. Board complies with time frames for issuing licenses, registrations, and endorsements, and for renewing licenses and registrations The Board complies with statutorily required time frames for issuing licenses, registrations, and endorsements. Statute requires the Board to establish time frames in rule for issuing licenses, registrations, and endorsements. These time frames are important because they provide information and an assurance to the public about what to expect in regard to having a license, registration, or endorsement approved or denied, and increase the Board s accountability if time frames are not met. If the Board does not meet its time frames, statute requires it to refund licensing, registration, or endorsement fees to applicants and pay a penalty of 2.5 percent of the applicant s fees to the State General Fund for each month that licenses, registrations, and endorsements are not issued or denied within the established time frames. The Board has established licensing, registration, and endorsement time frames in rule, and issues licenses, registrations, and endorsements in a timely manner, and also renews licenses and registrations in a timely manner. Rule requires the Board to issue initial licenses and registrations in 110 days and renew them in 60 days. 1 According to the Board s database, the Board issued its initial licenses, registrations, and endorsements in calendar years 2008 through 2012 within the time frame allowed in rule, with most issued within 30 days. Auditors also reviewed 16 randomly selected license/registration renewal applications from calendar year 2012 and associated database entries, and found that the Board renewed all 16 licenses/registrations in 3 days or less. 2 Recommendations: 1. The Board should further revise its licensing, registration, and endorsement application forms so that they are consistent with all of its rule requirements. 1 Rule requires the Board to process the 7 licenses and 2 registrations within 110 days. However, it gives the Board 60 days to process a funeral establishment s endorsement application to conduct prearranged funeral sales. 2 Endorsements were not included in auditors random sample. State of Arizona page 8

2. The Board should develop and implement policies and procedures to ensure that all licensure, registration, and endorsement requirements, including any future revisions to these requirements, are accurately reflected in its policies and procedures. 3. To ensure that the Board has an appropriate process for collecting late fees and ensuring that licensees/registrants reapply as required, the Board should develop and implement policies and procedures to guide the renewal process and ensure staff receive adequate supervisory oversight. 4. Where the information asked for in the Board s renewal applications differs from the information required by its administrative rules, the Board should determine whether to revise its renewal application forms or revise its rules. However, unless and until it revises its rules to change the renewal requirements, the Board should ensure its renewal application forms request all information required in rule. 5. To help ensure licensees/registrants meet the continuing education requirements, the Board should either follow up on a sample of renewal applications to verify that the licensee/registrant has completed the continuing education, or require all licensees/registrants to submit proof that they have completed the continuing education, such as a certificate of completion. Office of the Auditor General page 9

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Inspections The Board should ensure that its inspections are: (1) performed at each facility at least once every 5 years as required by statute, (2) thorough and welldocumented, and (3) accompanied by an appropriate follow-up process. Board should improve its inspection process to better protect consumers Arizona Revised Statutes (A.R.S.) requires the Arizona State Board of Funeral Directors and Embalmers (Board) to inspect all funeral establishments and crematories before initial licensure and at least once every 5 years. 1 The Board s inspector conducts these inspections by using a checklist to help ensure that these facilities comply with requirements in board statutes and administrative rules. Consistent with a recommendation from the Office of the Auditor General s 2003 performance audit of the Board, the Board developed inspection guidelines and rules to improve its inspection procedures (see Report No. 03-04). However, auditors identified several deficiencies in the inspection process. Specifically: Board failed to inspect about half of the facilities it regulates in time frame required by statute Although the Board is required to inspect all licensed facilities at least once every 5 years, and the Board regulates, on average, more than 200 licensed funeral facilities, auditors estimated, based on board records, that the Board inspected a total of only 92 facilities during calendar years 2008 through 2012. Inspecting funeral facilities is an important way for the Board to ensure that licensed facilities follow statute and rule requirements to protect consumers from deceptive or disrespectful business practices during an emotional time, and to ensure worker safety. For example, one Arizona crematory that had not been inspected in over 4½ years was the subject of a television station s news report in April 2011. The news report indicated that the crematory had stacked human bodies waiting for cremation in unrefrigerated vans for at least 19 hours because there were too many bodies to fit in the crematory s cooling system. Following the news report, the Board inspected the crematory and subsequently revoked its license. As a result of the audit, the Board became aware that it had not inspected about half of its licensed facilities as required in statute, and board staff began to catch up on its inspections. According to its database, the Board conducted 147 inspections from January through April 2013, and as a result, had inspected most of its actively licensed facilities at least once in the prior 5 years. Additionally, in May 2013, the Board indicated that it was in compliance with its inspection time frame requirement. Board failed to adequately document all inspection results, which could indicate incomplete inspections were conducted Although the Board has checklists to 1 A.R.S. 32-1307(A)(5)(h), 32-1383(C), and 32-1395(C) Office of the Auditor General page 11

assist in conducting inspections, the Board was not consistent or thorough in documenting inspection results. Auditors reviewed a random sample of 20 funeral facility inspection files, which contained checklists for one or more inspections conducted between calendar years 2002 and 2013, and found that for at least 12 of the inspection files, a checklist was not appropriately completed, or it was unclear if a violation had been found during the inspection. For example, the inspector rarely completed the entire portion of the checklist that involved a review of customer files to check for proper documentation such as permission to embalm or to cremate and to ensure that prices charged matched the prices advertised. An incomplete checklist could indicate an inspection was incomplete and prevent the Board from adequately protecting consumers and facility workers, as well as identifying and acting on patterns of noncompliance. Board neglected to appropriately conduct and document inspection followup Although the Board established follow-up procedures in its rules to help ensure facilities address deficiencies identified during inspections, the Board did not follow all of these procedures. For example, according to Arizona Administrative Code (AAC) R4-12-120(E), facilities with deficiencies are required to submit a written correction plan to the Board within 15 days of receiving the Board s inspection report, indicating the time frame for correcting the identified deficiencies. However, for the 20 funeral facility inspection files auditors reviewed, at least 16 facilities had one or more inspections with identified deficiencies, but none of these 16 files contained written corrective action plans, and board staff said they had not requested such plans from the facilities. In addition, although the inspector conducted some follow-up work after inspections, at least 8 of the 16 files with identified deficiencies contained insufficient information, either in the hard copy inspection files or the associated data entries in the Board s database, to determine whether the facility took corrective action for all deficiencies identified in an inspection. Further, when the inspector documented that a facility had taken corrective action, this was often based on verbal communication when physical documentation would have been more appropriate. For example, when a facility did not have casket price cards with complete information, the inspector verified that the deficiency was corrected by a phone call rather than by receiving a copy of the new price card. Board missing two items on its crematory inspection checklist The Board developed two checklists to guide inspections one for licensed funeral establishments and another for licensed crematories. These inspection checklists help guide the inspector s review of requirements based on applicable statutes and rules, with two exceptions. Specifically, the crematory checklist did not prompt the inspector to check for compliance with two statutory requirements: (1) displaying the licenses of the crematory and the responsible cremationist, and (2) disposing of all body prostheses, bridgework, or similar items removed from the cremated remains unless other arrangements are made in the authorization to cremate. During the audit, the Board revised its crematory inspection checklist to ensure that crematories comply with these two statutory requirements. Auditors identified several factors that contributed to these deficiencies. These included an inadequate inspection policy and a lack of oversight such as supervisory review to ensure that inspections were completed at the required frequency and properly documented, and that appropriate followup was conducted. For example, the Board s inspection policy does not require State of Arizona page 12

its staff to formally track its compliance with the 5-year inspection requirement. In addition, the Board did not request any specific reports from staff to ensure it met or would meet the 5-year requirement even though it received budget cuts and lost funding for a staff member in 2008, and had an Executive Director who was ill for several months between calendar years 2010 and 2012. In contrast, auditors contacted five other states agencies responsible for conducting routine inspections of funeral facilities, and officials at all five agencies reported that oversight for their state s inspection process for funeral facilities is achieved through agency staff review of inspection reports and/or tracking how long it had been since each facility s last inspection. 1 In response to the audit, the Board began to take action to address some of these issues. Specifically, the Board hired a new inspector to replace its retiring inspector, and the new inspector developed a monitoring tool to help ensure that licensed facilities will be inspected once every 2 years. A board official reported that the Board would like to inspect facilities once every 2 years to help licensees voluntarily comply with statutes/rules and to help prevent complaints from occurring. The board official indicated that this instruction had been provided to the prior inspector as well. To enhance oversight, the Board reported that the inspector and Executive Director will meet every other week to review inspection progress and plans. In addition to these actions, the Board should revise its inspection policies and procedures and implement them. Specifically, the revised policies and procedures should ensure that the Board and the Executive Director adequately oversee the inspection process and ensure that its staff do the following: Inspect all facilities at least once every 5 years The Board should revise its inspection policies and procedures to ensure that all licensed facilities are inspected at least once every 5 years, and more frequently as resources permit. The policies and procedures should describe how staff will track inspection progress and report compliance with the 5-year requirement to the Board. Consistently document all inspection results The Board should revise its inspection policies and procedures to require that inspection checklists be fully completed and that there are no checklist items left unchecked without an explanation. In addition, a periodic supervisory review of the inspector s checklists should be required to ensure that checklists are clearly and accurately completed. Appropriately follow up on deficiencies found in inspections and document corrections The Board should revise its inspection policies and procedures to ensure that staff (1) conduct follow-up activities as required by AAC R4-12-120, including requesting written corrective action plans; (2) document whether and when corrective action is taken; and (3) obtain appropriate evidence to verify that deficiencies have been corrected. In addition, the policies and procedures should require the Board s Executive Director to randomly review inspection files and associated database entries at a specified, regular interval to ensure required follow-up activities have been performed. 1 Auditors contacted other states funeral regulation agencies in five western states as follows: California, Idaho, Nevada, Oregon, and Washington. Office of the Auditor General page 13

As of June 2013, the Board had begun revising its inspection procedures to help ensure facilities are inspected in a timely manner and that the inspector appropriately documents inspection results on the checklist. The Board should continue its efforts to revise its written policies and procedures and implement them. Finally, the Board should ensure that licensees are disciplined if the inspector finds serious deficiencies after an inspection. As indicated in AAC R4-12-120(G), the Board should not allow an applicant or licensee an opportunity to correct the deficiencies if the deficiencies: (1) are committed intentionally, (2) evidence a pattern of noncompliance, or (3) are a risk to the public health, safety, or welfare. For these types of deficiencies, the Board may investigate and take disciplinary action as needed. Although board staff indicated that they have not encountered deficiencies that meet the three criteria mentioned previously, the Board has no guidance to help staff determine when deficiencies meet the criteria, or to describe how the Board would subsequently take disciplinary action. Therefore, the Board should develop and implement policies and procedures that provide direction to its staff on appropriately identifying and informing the Board of deficiencies that meet these three criteria, and that provide guidance to the Board for taking appropriate disciplinary action to address serious deficiencies identified during an inspection. Recommendations: 1. The Board should revise and implement its inspection policies and procedures to ensure that: a. All licensed facilities are inspected at least once every 5 years; b. Staff track inspection progress and report compliance with the 5-year requirement to the Board; c. Inspection checklists are fully completed and that there are no checklist items left unchecked without an explanation, and to require a periodic supervisory review of the inspector s checklists to ensure that checklists are clearly and accurately completed; d. Board staff (1) conduct follow-up activities as required by AAC R4-12-120, including requesting written corrective action plans; (2) document whether and when corrective action is taken; and (3) obtain appropriate evidence to verify that deficiencies have been corrected; and e. The Board s Executive Director randomly reviews inspection files and associated database entries at a specified, regular interval to ensure required follow-up activities have been performed. 2. The Board should develop and implement policies and procedures that provide direction to its staff on appropriately identifying and informing the Board of deficiencies that meet the three serious deficiency criteria specified in AAC R4-12-120(G), and that provide guidance to the Board for taking appropriate disciplinary action to address serious deficiencies identified during an inspection. State of Arizona page 14

Complaint resolution The Board adequately investigated and resolved complaints in a timely manner. Board adequately investigated and resolved complaints in a timely manner The Arizona State Board of Funeral Directors and Embalmers (Board) is responsible for investigating complaints against licensed or registered individuals and licensed facilities and for taking nondisciplinary or disciplinary action, as necessary. Statute authorizes the Board to investigate complaints alleging violations of statute and/or board administrative rules, including professional incompetence, unprofessional conduct, and failing to be honest, responsive, and sensitive to needs concerning funeral arrangements. Complaints may be submitted by the public or initiated by the Board, and are investigated by board staff. Based on its review of investigative reports, the Board may dismiss complaints or take nondisciplinary or disciplinary action, as appropriate. The Board s available nondisciplinary action is to issue a letter of concern, and its disciplinary options include letters of reprimand, probation, civil penalties, suspension, and revocation. In calendar years 2010 through 2012, the Board opened 15 complaints: 6 were dismissed, 4 resulted in nondisciplinary letters of concern, and 5 resulted in discipline. Auditors found that the Board adequately investigated and adjudicated these complaints and resolved them in a timely manner. Specifically, the Board: Adequately investigated complaints Auditors reviewed the 15 complaints the Board opened in calendar years 2010 through 2012 and found that for all 15 complaints, board staff conducted appropriate and thorough investigations, including performing inspections, interviewing involved parties, and collecting and reviewing evidence and written statements of those involved. Board staff prepared thorough investigative reports that summarized allegations, evidence, and potential violations. Dismissed complaints when no violations found and issued discipline for violations Based on auditors review of the 15 complaints, observation of board meetings, and review of board meeting minutes, the Board dismissed unsubstantiated complaints and took action when it found violations. For example, the Board dismissed complaints that lacked sufficient evidence of a violation of statute or rule. However, when the Board determined that a licensee violated statute or rule, it imposed discipline. Further, it escalated discipline for repeat violators. For example, for a complaint involving a crematory that was responsible for partially cremated remains scattered throughout a cemetery, the Board was aware that the responsible cremationist had already received discipline once for unprofessional conduct, which is a statutory violation. The discipline for the prior violation included a fine and order to complete continuing education courses. In response to the statutory violations in the Office of the Auditor General page 15